Search form

Search form

The Office of Inspector General for the Department of Veterans Affairs is inspecting the VA Pittsburgh Healthcare System in light of the Legionella outbreak last year, in which one patient died. The office also is examining the responses of about 150 VA medical centers to 2007 guidance on preventing Legionnaires' disease.

Related Summaries

Janet Stout, a former infection-prevention specialist with the VA Pittsburgh Healthcare System, informed the Department of Veterans Affairs' Inspector General about problems with detecting Legionella 18 months before a deadly outbreak at the hospital system, according to a report. Stout says the Pittsburgh hospital was "ill-equipped" to investigate the complaint, while VA spokesman Mike Marcus says the laboratory was "fully accredited" to test for Legionella.

The VA Pittsburgh Healthcare System experienced systemic problems during a 2011 and 2012 outbreak of Legionnaires' disease, including a "lack of clarity" about how to manage the water-treatment system designed to keep Legionella in check, according to a report by the Veterans Affairs Office of Inspector General. The hospital system also neglected to test all suspected pneumonia patients for the disease, and facilities-management and infection-control personnel failed to communicate adequately, the report said.

The U.S. Department of Veterans Affairs is examining more than 150 VA hospitals' compliance with its inspector general's 2007 report aimed at preventing Legionnaires' disease. The nationwide investigation began in December after Pennsylvania lawmakers raised concerns in light of five deaths at the VA Pittsburgh Healthcare System that have been linked to Legionella.

Two Pittsburgh Veterans Affairs hospitals didn't formally tell patients about a Legionella risk at the facilities, which may be a violation of federal regulations, said lawyers representing the families of two deceased veterans. Tap water at the hospitals is suspected of causing Legionnaires' disease in 21 patients. One of the families said they intend to file a lawsuit.

A Department of Veterans Affairs hospital in Pittsburgh and other facilities use an ionization system to avert Legionnaires' disease outbreaks, according to this article. But officials with the Centers for Disease Control and Prevention call chlorinated products "the best strategy" for fighting legionella, rather than ionization technology, which the Pittsburgh hospital adopted nearly 20 years ago. "Other hospitals with [ionization] systems should carefully review their continued usage of this system," CDC spokeswoman Alison Patti said.